Management of infection following reconstruction in bone tumors

Kapoor, Satwanti; Thiyam, Rajesh

doi:10.1016/j.jcot.2015.04.005

Cited by 38 publications

(25 citation statements)

References 92 publications

(99 reference statements)

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“…In the modern era of limb salvage surgery, primary sarcomas of bone are typically treated with wide resection followed by reconstruction with allograft bone, an endoprosthesis, or an allograft‐prosthetic composite, in addition to chemotherapy and/or radiation therapy . However, postoperative complications such as infection remain a significant clinical challenge, as periprosthetic joint infections (PJI) can result in the need for additional surgeries, amputation, and even death . While features such as age, size, location, histologic grade, and presence of pulmonary metastases can predict prognosis for patients with bone sarcomas, they represent static attributes that cannot be actively optimized to improve outcome.…”

Section: Discussionmentioning

confidence: 99%

“…17 However, postoperative complications such as infection remain a significant clinical challenge, as periprosthetic joint infections (PJI) can result in the need for additional surgeries, amputation, and even death. 2,18 While features such as age, size, location, histologic grade, and presence of pulmonary metastases can predict prognosis for patients with bone sarcomas, 14,19,20 they represent static attributes that cannot be actively optimized to improve outcome.…”

Section: Discussionmentioning

confidence: 99%

“…However, postoperative infection remains one of the most challenging problems following limb salvage. Patients are neutropenic from chemotherapy, experience impaired wound healing due to radiation therapy, and/or have large endoprosthetic or allograft reconstructions that can harbor bacteria . Infections occur in 12% to 15% of allograft or endoprosthetic reconstructions and are associated with the significant morbidity of additional surgeries and/or amputations …”

Section: Introductionmentioning

confidence: 99%

“…Patients are neutropenic from chemotherapy, experience impaired wound healing due to radiation therapy, and/or have large endoprosthetic or allograft reconstructions that can harbor bacteria. 2 Infections occur in 12% to 15% of allograft or endoprosthetic reconstructions and are associated with the significant morbidity of additional surgeries and/ or amputations. 3,4 Abnormal body mass index (BMI) has been found to be associated with worse survival in Ewing's sarcoma and with postoperative infections in osteosarcoma.…”

Section: Introductionmentioning

confidence: 99%

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Is malnutrition associated with postoperative complications in patients with primary bone sarcomas?

Park

Lans

Raskin

et al. 2018

Journal of Surgical Oncology

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Background Modifiable risk factors that can be optimized to minimize postoperative complications in patients with bone sarcomas are yet to be identified. Methods We retrospectively identified 275 patients aged 18 and older who underwent surgery for primary bone sarcomas who also had albumin values recorded within 4 weeks before surgery. Postoperative complications were defined as infection, hematoma, need for additional surgery, or wound complications. Results In the multivariate analysis, age (P = 0.049) and neoadjuvant radiotherapy (P = 0.008) were independently associated with postoperative complications. We then performed a subanalysis of patients without a pelvic tumor who also did not receive radiotherapy (n = 178). In this population, albumin less than 2.8 g/dL was found to be independently associated with postoperative complications (odds ratio [OR], 4.69. 95% confidence intervals [CI], 1.03‐21.97; P = 0.046). Conclusions This study demonstrates that hypoalbuminemia (albumin < 2.8 g/dL) is associated with postoperative complications in patients with nonpelvic bone sarcomas who do not receive radiation. Future studies are necessary to further elucidate the role of nutrition, and they may show that nutritional status is a modifiable risk factor that can be optimized to improve the outcome of surgery for primary bone sarcomas.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is malnutrition associated with postoperative complications in patients with primary bone sarcomas?

Park

Lans

Raskin

et al. 2018

Journal of Surgical Oncology

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“…Periprosthetic infection in megaprosthesis reconstruction after massive bone tumour resection is an enormous problem for orthopaedic tumour surgeons. Not only the risk of megaprosthesis infection is high (3-31%) due to multiple unfavourable factors such as a big wound, lengthy surgery, lack of soft tissue coverage and chemotherapy [1][2][3] but also the management outcome is not very satisfactory. The megaprosthesis infections were categorized as 'acute' if they occurred within 4 weeks post-operatively, as 'early' if within 4 weeks to 2 years post-operatively or 'late' if more than 2 years.…”

Section: Introductionmentioning

confidence: 99%

Antibiotic-laden cement wrap: A simple but effective way of treating patients with megaprosthesis infection

Lam

Yau

et al. 2019

J Orthop Surg (Hong Kong)

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Infection is one of the commonest causes for megaprosthesis failure. The current treatment includes antibiotics but no surgery, debridement, prosthesis removal and joint fusion, prosthesis revision or amputation. Success in controlling infection may be less than 50% in implant revision. The overall risk of amputation is more than 20%. We believe that repeated debridement with antibiotic-laden cement wrap (ALCW) may be a reliable alternative for managing the megaprosthesis infection. The purposes of this article are to identify whether ALCW is an effective way of eradicating the megaprosthesis infection, the associated complications and the functional outcome after management by ALCW. Methods: This was a retrospective study of patients with megaprosthesis infection. From January 2014 to June 2016, there were five patients with tumour megaprosthesis infection who had undergone the ALCW procedure. Ages ranged from 17 to 59 years of age. Male to female ratio was 4:1. The patients studied had humeral (1), proximal femoral (1), distal femoral (1) and proximal tibial (2) prostheses. All patients had follow-ups more than 1 year (21-52 months) after treatment. Results: All patients recovered from their implant infection and the implants were retained in all patients. There was no sign of infection in the most recent follow-up. One patient died of osteosarcoma recurrence. One patient had a large block of cement causing plastic insert dislodgement in the shoulder joint 1 year after surgery. Another patient with a dislocated hip cup had revision carried out in the final debridement. The most recent Musculoskeletal Tumor society (MSTS) scores ranged from 21 to 30. All patients were satisfied with their treatment. Conclusions: In this preliminary report of a small number of patients, ALCW has achieved 100% infection control. ALCW may be an easy and effective alternative for managing the megasprosthesis infection. The complications associated can be avoidable. The functional outcome is excellent.

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Incidence, Complications and Novel Treatment Strategies: Massive Bone Tumour Surgery

Mumith

Osagie²

2022

Musculoskeletal Infection

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Management of infection following reconstruction in bone tumors

Cited by 38 publications

References 92 publications

Is malnutrition associated with postoperative complications in patients with primary bone sarcomas?

Is malnutrition associated with postoperative complications in patients with primary bone sarcomas?

Antibiotic-laden cement wrap: A simple but effective way of treating patients with megaprosthesis infection

Incidence, Complications and Novel Treatment Strategies: Massive Bone Tumour Surgery

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